Sunday, January 7, 2018

Reverse total shoulder arthroplasty for irreparable rotator cuff dysfunction

These authors reported their observations on 22 reverse total shoulders ( Delta III prosthesis (DePuy, Saint-Priest, France)) in patients having irreparable rotator cuff dysfunction with a mean age of 68 years at a mean followup of 16 years.

The indications for these procedures were an irreparable rotator cuff tear and secondary pseudoparalysis of active anterior elevation.  Rotator cuff tears were considered irreparable if pseudoparalysis was chronic (ie, >3 months), if the acromiohumeral distance was <7 mm on a plain anteroposterior radiograph, or if the fatty infiltration of the supraspinatus and infraspinatus or supraspinatus and subscapularis muscles was greater than stage 2 according to Goutallier. Pseudoparalysis was defined as an active anterior elevation of <90° with preserved, free passive anterior elevation.

The mean absolute Constant score (CS) improved from 23 to 58 points and the relative CS  from 30% to 73% 23% at final follow-up. The mean rCS  did not significantly deteriorate over 15 years. One or more complications were recorded in 13 patients (59%), with 6 failed RTSAs (27%).

Most of the re operations were performed soon after the index RTSA; two-thirds of the reoperations took place in the first two years.

The authors conclude, "Although RTSA for severe shoulder dysfunction due to an irreparable rotator cuff tear yielded stable and substantial improvement in shoulder function and subjective outcome after a mean of 16 years, it is associated with a substantial complication rate. Patients need to be advised about realistic expectations regarding RTSA in the long-term, emphasizing a substantial but controllable complication rate and reduced overhead function over time."

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